Ed Raby

Reminds me of the excellent editorial by Dr Burke Cunha highlighting the potential clinical relevance of testing antibiotics at urinary concentrations, in medium with urinary pH.

Doxycycline for Pseud UTI?

Eur J Clin Microbiol Infect Dis 31, 2865–2868 (2012)
rdcu.be/enkNP

Meropenem initially, once stable, switch to subcutaneous ertapenem 1g daily (assuming renal fn ok) to complete 7 days. Longer if renal tract imaging shows abscess. SubCut is well tolerated, avoids need for IV access and achieves good pK

Sprinkles and washes ... the true extent of topical rifampicin use during surgery is unclear due to lack of documentation - a huge opportunity for stewardship and better governance
bit.ly/42nFmQT
Thanks to my co-authors Matt Rawlins and @edraby.bsky.social

#AMS #off-label #rifampicin #AMR #NAUSP

Relevant for roadmap as well - may be informative to specifically collect use of menopausal hormone therapy

Influence of gender on age-associated in-hospital mortality in patients with sepsis and septic shock: a prospective nationwide multicenter cohort study - Critical Care Background Numerous epidemiological studies investigating gender-dependent clinical outcomes in sepsis have shown conflicting evidence. This study aimed to investigate the effect of gender on in-hospi...

Appears to be different trajectories for women 19-50 to those over 50 in this large sepsis cohort. Pregnancy-associated, hormonal, more frequent UTI, differences in care seeking/delivery or something else??

doi.org/10.1186/s130...

Should this be further separated into (presumptive) pre- and post-menopause?

Highlighting undocumented off-label topical use of rifampicin during surgery in Australian hospitals, and opportunities for AMS #Antimicrobials2025 #ASA2025 #rifampicin #surgery #AntimicrobialStewardship @edraby.bsky.social #MattRawlins

I think this is the point the authors make in their discussion - a proportion of the diagnoses were probably wrong. Patients may have been adequately treated with "limited" spectrum antibiotics or no antibiotics at all. And yet, they did worse when exposed early to broad.

#idsky

Nice analysis!

But not an entirely fair competition. Temp measured daily whereas less frequent CRP - fewer on any day and so wider confidence intervals. The point estimates of ORs for 50% fall CRP ok and consistent after day 4.

Can probably get more out of CRP with kinetic models that include age

They used a well constructed propensity score to drive the matching and looked at sicker (ICU admit) and less sick subgroups. The favorable outcome for delayed broad therapy held true for all but septic shock.

Great hypothesis in discussion as to why this might be...

#idsky

Oral vs Intravenous Antibiotics for Patients With Klebsiella pneumoniae Liver Abscess: A Randomized, Controlled Noninferiority Study In this randomized noninferiority trial of 152 patients with Klebsiella pneumoniae liver abscess, the proportion criteria for clinical cure with early oral

academic.oup.com/cid/article/...

In this RCT of klebsiella liver abscess, they stopped antibiotics if there had been reduction in maximum dimension on imaging and (zombie alert) CRP <20. Assessed at 4 weeks post randomisation, if criteria not met, reassessed every 2 weeks. About 70% had drainage (50% pre and 15-20% post-enrolment)

Not an RCT, but 50 cases of adult meningococcal meningitis in this NZ cohort treated with median 3 days ceftriaxone.

Matthew Broom et al. Infection. 2023 Apr.
pubmed.ncbi.nlm.nih.gov/35982367/

Levo CSF levels slightly higher than moxi in this TBM study, although doses received is unclear. Authors conclude "Assuming susceptible MICs of ... 0.5 mg/L for levofloxacin and moxifloxacin, levofloxacin may have the best potential to achieve PK/PD targets"

doi.org/10.3389/fpha...

We report doxy for all MRSA and MSSA isolates except for those from blood cultures.

However, our "doxy" is extrapolated from the tet result so probably underestimates susceptibility by 10% 😢

You missed doxy....
MRSA 96.7%
MDR MRSA 90.1%
👍👍